=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508397860
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HAKEEM MALIN DNP, PRACTITIONER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2017
-----------------------------------------------------
Last Update Date | 04/05/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1000 GEORGESVILLE RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43228-3304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-274-7771
-----------------------------------------------------
Fax | 614-274-7720
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1000 GEORGESVILLE RD
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43228-3304
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-274-7771
-----------------------------------------------------
Fax | 614-274-7720
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.020612
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------